Information on this page may not
be used for personal or financial gain.
It is to be used for research only. Thank you.
Please understand that some of the
handwriting was faded, incomplete, and poorly written,
therefore, some errors in transcribing may have occurred.
Register of Death Information
(1) Full Name of Deceased (2) Date of Death (3) Place of Birth of
Deceased (4) Sex & Color (5) Occupation
(6) Age, Years, Months, Days (7) Status, Married, Single,
Widowed (8) Full Name of Father of Deceased
(9) Place of Birth of Father of Deceased (10) Full Name of Mother of
Deceased
(11) Place of Birth of Mother of Deceased (12) Place of Death of Deceased
(13) Chief Principal Disease Causing Death (14) Contributory Disease
Causing Death
(15) Did Deceased Undergo A Surgical Operation, And If So, When And Of What
Nature
(16) Place of Interment of Deceased (17) Informant, Doctor,
Midwife, or Head of Family
(18) No. of Certificate (19) Remarks